222例分化型甲状腺癌再手术的临床分析

目的 分析分化型甲状腺癌（DTC）再手术的原因,总结减少再次手术的策略。方法 回顾性分析2013年1月至2017年12月于重庆医科大学附属第一医院内分泌乳腺外科行手术治疗分化型甲状腺癌再次手术的患者222例,根据其初次手术前的临床评估情况,将患者分为cN0分化型甲状腺癌（DTC cN0）、cN1分化型甲状腺癌（DTC cN1）、分化型甲状腺癌未评估（DTC unknown）及甲状腺良性病变组,随访统计其再次手术间隔时间、初次手术方式及再次手术区域,分析总结其再次手术的原因及对策。结果 222例中甲状腺乳头状癌（PTC）219例,滤泡状癌（FTC）3例;首次手术术前或术中评估为DTC cN0 63例（284%）,DTC cN148例（216%）,DTC unknown27例（122%）,甲状腺良性肿瘤组84例（378%）。首次手术为良性肿瘤组再次手术均在1年内,DTC cN0组为13个月（15天～132个月）,DTC cN1为12个月（4～18个月）。在DTC cN0组中初次手术方式为甲状腺全切+患侧中央区淋巴结清扫或甲状腺全切有40例（占635%）;在DTC cN1组中初次手术方式为甲状腺全切+患侧中央区及侧区淋巴结清扫有39例（813%）。侧区淋巴结出现转移是DTC再次手术的主要原因,DTC cN0组同侧Ⅲ区出现复发的频率最高为597%;DTC cN1组同侧Ⅱ区复发为500%。结论 首次手术术前及术中对甲状腺肿瘤进行精确的评估能减少再次手术的发生,而对于首次手术术前评估为DTC的患者首次手术前对颈侧区淋巴结转移情况进行准确的评估以及规范的手术切除范围能够减少DTC术后复发。     

86例青少年甲状腺癌的临床分析

目的 探讨青少年甲状腺癌的临床病理特点、最佳治疗方法及预后。方法 86例患者均以手术治疗为主,辅以内分泌治疗,少数患者加^131Ⅰ内照射治疗。结果 全组乳头状癌73例(84．9％),滤泡状癌6例(7．0％),乳头滤泡状癌4例(4、7％),髓样癌3例(3．5％)。颈部淋巴结转移59例(68．6％),其中双侧甲状腺癌并双颈部淋巴结转移者16例,占27.1％。肺转移11例。术后复发6例。本组颈部淋巴结转移率、双侧甲状腺受侵犯伴双颈淋巴结转移率、肺转移率均明显高于成年人。84例获5年以上随访,5年生存率95．3％(82／86)。41例获10年以上随访,10年生存率87．8％(36／41)。结论 青少年甲状腺癌颈部肿块临床表现大多数无特异性,难以与其他颈部肿块鉴别,易误诊,应引起临床高度重视。治疗手段以手术为主,预后良好。既使已有肺转移,手术加^131Ⅰ内照射的综合治疗仍能获得较满意疗效。     

甲状腺乳头状癌雌激素受体的检测

目的：探讨甲状腺乳头状癌雌激素受体阳性表达的临床病理意义。方法：应用免疫组化ＳＰ法对８０太腺乳头状癌,３０例滤泡状癌及５０例癌旁正常甲状腺组织雌激素受体（ＥＲ）进行测定。结果：甲状腺乳头状癌、滤咆状癌及正常组织ＥＲ阳性率分别为６７．５０％（５４／８０）、２３．３３％（７／３０）、６％（３／５０）,乳头状癌ＥＲ阳性率显著滤泡状癌及正常组织,乳头状癌中原发癌ＥＲ阳性率显著高于复发癌,无淋巴结转移者ＥＲ     

青少年甲状腺癌25例临床分析

目的:分析探讨青少年甲状腺癌的临床特点、诊治及预后。方法:回顾性分析我院1993~2006年间收治的18岁以下青少年甲状腺癌患者25例。结果:乳头状腺癌21例,滤泡状癌2例,乳头滤泡状癌2例。均行手术治疗,患侧腺叶加峡部切除6例,患侧腺叶加峡部切除及对侧大部切除17例,甲状腺全切术2例,单侧功能性颈淋巴结清扫术15例,双侧颈清扫术4例,术后病理示颈淋巴结转移19例。所有患者术后均予甲状腺素治疗。平均随访8年(1~14年),5年生存率92.0%,获10年随访患者10年生存率86.9%。结论:青少年甲状腺癌预后较佳,治疗的关键是正确根据其病理类型和病情选择合适的手术方式。     

Papillary thyroid carcinoma and related thyroid neoplastic lesions: a light microscopic study with emphasis on nuclear changes

A total of 187 thyroid lesions consisting of 2 cases of Grave's disease, 21 cases of multinodular goiter, 40 follicular adenomas and 124 low-grade papillary thyroid carcinomas were studied to identify intermediate neoplastic lesions in the spectrum of nuclear changes between benign reactive thyroid follicles and low-grade thyroid papillary carcinoma. The lesions were examined and classified on the basis of the following nuclear features: fine chromatin seen in the thyroid papillary carcinomas and coarse chromatin seen in follicular carcinomas. Cases with Hürthle cell changes were excluded from the study. Cases with nuclei containing coarse chromatin were classified in the group of follicular adenomas with a coarse chromatin pattern. The neoplastic thyroid lesions containing fine chromatin showed a spectrum of nuclear changes ranging between reactive follicular lesions and papillary thyroid carcinoma with lymph node metastasis. Such lesions were classified as follicular adenomas with a fine chromatin pattern. The nuclei of these lesions were graded into mild to marked "nuclear atypia with a fine chromatin pattern". The degree of atypia depended on the degree and extent of nuclear changes. Encapsulated follicular adenomas with a fine chromatin pattern and with mild atypia (11 cases), moderate atypia (13 cases), marked atypia (27 cases), and encapsulated or nonencapsulated papillary thyroid carcinoma were characterized by uniform nuclei; with mild, moderate and marked nuclear atypia in less than 2/3 of the cell population and marked nuclear atypia in more than 2/3 of the cell population; and measuring 5.4-6.3, 6.0-7.2, 6.3-9 and 7.2-10 microns in diameter, respectively. Follow-up of cases of papillary thyroid carcinoma fulfilling the above criteria showed lymph node metastasis in 33% of cases, whereas follicular adenomas with a fine chromatin pattern, including cases originally diagnosed as papillary carcinoma, showed no evidence of lymph node or distant metastasis in a follow-up period of 30 months to 15 years. In the thyroid tissue surrounding papillary thyroid carcinoma or encapsulated follicular adenoma with a fine chromatin pattern and marked atypia, adenomatous nodules with a fine chromatin pattern and with low-grade nuclear atypia were identified. The adenomatous nodules with a fine chromatin pattern and with mild, moderate and marked atypia showed architectural, cytoplasmic and nuclear features similar to those of follicular adenoma with a fine chromatin pattern of the same grade. Of interest, a large number of cases of follicular adenoma with a fine chromatin pattern had areas with features of follicular adenoma with a coarse chromatin pattern.     

分化型甲状腺癌组织中存活素蛋白的表达与细胞增殖和凋亡的关系

背景与目的： 探讨分化型甲状腺癌(differentiated thyroid carcinoma, DTC)组织中存活素(Survivin)蛋白的表达与细胞增殖和凋亡活性的关系,以及在甲状腺癌发生、发展过程中的作用机制及可能的作用途径。 材料与方法： 采用末端脱氧核苷酸转移酶标记(TUNEL)法及免疫组化技术分别对10例结节性甲状腺肿(结甲)、10例甲状腺滤泡状腺瘤、30例甲状腺乳头状癌、12例甲状腺滤泡状癌组织中细胞凋亡指数(apoptosis index,AI)、细胞增殖核抗原增殖指数(PCNA-LI, PI)和Survivin蛋白的表达进行检测。 结果： 甲状腺癌组中Survivin蛋白的表达阳性率均显著高于对照组结甲和腺瘤中的阳性表达率;甲状腺癌组织中Survivin的表达与淋巴结转移和临床分期有关(P<0.05);且Survivin蛋白表达阳性组和阴性组的AI和PI均呈负相关(r分别为－0.72和－0.80,P均<0.01);分别比较Survivin蛋白表达阳性组和阴性组的AI及PI,两组间AI和PI的差异均具有统计学意义(P<0.01)。 结论： Survivin与分化型甲状腺癌细胞增殖和凋亡关系密切,在甲状腺癌发生发展过程中发挥重要的作用。     

甲状腺癌相关因素研究

研究证明肥胖为 DTC 发病危险因素；碘能增加甲状腺乳头状癌的发病风险，却能降低滤泡癌的发病风险；维生素 D 能降低 DTC 的发病风险，但仍没有足够证据证明维生素 A、C、E 能降低 DTC的发病风险；酒精可能降低 DTC 发病风险，但内在机制仍不清楚；摄入外源毒素增加 DTC 发病风险。明确保护因素与危险因素对于 DTC 的预防工作有十分重要的意义。     

儿童甲状腺癌14例临床分析

目的 探讨儿童甲状腺癌的临床特点,诊断原因,治疗及预后。方法 回顾性分析１９７７～１９９７年 治的１４岁以下儿童甲状腺癌１４例,按１９８９年国际抗癌联盟（ＵＩＣＣ）临床病理分期标准复习病理和分期。结果 乳头状癌１２例（８３．３％）,滤泡状癌２例（１６．７％）。１期１３例,２期１例。直接误诊７例。单侧胜颈清扫术１１例,双侧颈清扫术２例,姑息性甲状腺次全切除,术后病理示颈淋巴结转移阳性者１２例（８５．     

血型抗原Lewis A和Lewis X在甲状腺乳头状癌中的表达

目的 :探讨血型抗原LewisA和LewisX在甲状腺乳头状癌中表达的意义。方法 :采用免疫组织化学EnVision方法 ,测定血型抗原LewisA和LewisX在 70例甲状腺乳头状癌和 70例癌旁正常甲状腺滤泡上皮 ,以及 16例甲状腺滤泡性腺瘤、17例结节性甲状腺肿和 14例桥本氏甲状腺炎中的表达。结果 :LewisA和LewisX在甲状腺乳头状癌中的表达阳性率分别为 94 3% ( 66/ 70 )和 85 7% ( 60 / 70 ) ,癌旁正常甲状腺滤泡上皮中的表达阳性率分别为 2 9% ( 2 / 70 )和 5 7% ( 4 / 70 )。肿瘤直径≥ 1cm组LewisX的表达强度较肿瘤直径 <1cm组明显增高 ,P <0 0 1。淋巴结转移组LewisX的表达强度较非转移组显著增高 ,P <0 0 1。结论 :LewisA和LewisX可作为诊断甲状腺乳头状癌的参考指标。LewisX的表达强度与肿瘤浸润及转移有关     

New subgrouping of small thyroid carcinomas

Clinicopathologic findings on small thyroid carcinomas measuring 10 mm or less in diameter were analyzed in 78 thyroidectomied cases. The authors divided small thyroid tumors into two subgroups according to diameter: 0 less than or equal to 5 mm (classified as minute carcinoma) and 5 less than 0 less than or equal to 10 mm (classified as tiny carcinomas). Characteristics including sex, age, histologic type, extrathyroid invasion, and lymph node metastasis were examined in each subgroup. In patients with minute carcinoma, very few incidences of extrathyroid invasion and lymph node metastasis were found. However, these involvements, especially lymph node metastasis, were found more frequently in patients with tiny carcinoma. The incidence of cervical lymph node metastasis was 13% in minute carcinoma and 59% in tiny carcinoma. (P less than 0.01). These findings suggest the need for more careful observation and treatment of tiny carcinomas, especially with respect to lymph node metastasis. In accordance with World Health Organization (WHO) classification, the histologic types of thyroid carcinoma were classified into papillary and follicular carcinomas. The papillary carcinoma and follicular carcinoma ratios were compared between the two subgroups. The discovery rate of follicular carcinoma was significantly higher in minute carcinoma than in tiny carcinoma (P less than 0.005). This suggests that the papillary carcinoma/follicular carcinoma ratio (p/f) increases as the size of the carcinoma increases, and that follicular carcinoma is the "seed," or initial form, of thyroid cancer. The female-male ratio in small thyroid cancer suggests that there is no sex difference in carcinogenesis but that there is more probability for cancer development in the thyroid in women.     

甲状腺癌的再次手术治疗

目的：探讨甲状腺癌再次手术的必要性及其手术方式，分析再次手术的原因。方法：回顾性分析我科于1999年2月～2002年10月，45例甲状腺癌再次手术的临床资料。结果：首次行甲状腺肿块切除术的有43例，行甲状腺患叶 峡部切除术的2例。首次手术后的病理类型：乳头状腺癌32例，滤泡性腺癌12例，髓质样癌l例。根据外院手术治疗资料及我院术前彩色多普勒超声检查或CT检查结果，均再次行手术治疗，其中再次行甲状腺残叶 峡部切除术的28例，行甲状腺残叶 峡部 同侧功能性颈清扫的17例。再次手术后病理检查证实癌残留的29例(67．4％)，颈部淋巴结有转移癌的有12例(70．6％)，随访至今均生存。结论：甲状腺癌行局部切除术，残癌率高，再次手术是必要的。     

Preoperative serum MMP-9 immunoreactive protein is a prognostic indicator for relapse-free survival in breast carcinoma

Tob, a member of the Tob/BTG family, is a novel anti-proliferative protein, but it becomes inactive when phosphorylated. In this study, we investigated whether Tob is phosphorylated and inactive in various thyroid neoplasms in order to elucidate how this event plays a role in their progression. Tob phosphorylation was only occasionally seen in normal follicular cells. A high level of Tob phosphorylation was observed in 42.1% of follicular adenoma, 14.3% of follicular carcinoma. In papillary carcinoma, the Tob phosphorylation level was elevated more frequently than that in follicular carcinoma, and 39.7% of specimens were classified in the high group. Tob phosphorylation level in papillary carcinoma was directly linked to tumor size, lymph node metastasis, extrathroid extension and the presence of poorly differentiated lesion. In anaplastic carcinoma, surprisingly, Tob phosphorylation was not observed in any cases, but the deficiency of Tob expression was also observed in all these cases. These results suggest that (1) Tob phosphorylation contributes to the progression of papillary carcinoma especially in the later phase through cancellation of its anti-proliferative function, and (2) the deficiency of Tob expression is attributable to the lack of Tob phosphorylation in anaplastic carcinoma.     

Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type

Time trends in the incidence of malignant neoplasms of the thyroid were examined for Sweden for the period 1958-81, 5,838 cases being studied. Autopsy-diagnosed cases were excluded. Mean annual changes in the age-standardized rates over this period were 1.9% and 1.2% for women and men, respectively, for all thyroid carcinomas combined; 4.9% and 2.1% for papillary carcinoma; 0.9% and 2.1% for follicular carcinoma; and -1.0% and -2.1% for anaplastic carcinoma. Age, period and cohort models were fitted. There was a progressive increase in papillary cancer incidence for cohorts born since 1919. This increase cannot be satisfactorily explained as an artefact of trends in classification, and probably reflects a real increase in incidence. A less marked increase was seen for follicular cancer, and there was a decline for cohorts born since 1939. While the risk of papillary and anaplastic carcinoma was lower in iodine-deficient areas, follicular cancer risk was twice as high in these areas, for men only. There was a steady decline of anaplastic cancer in both sexes after 1965, largely attributable to a decline in cohorts born since 1924.     

E-cadherin在甲状腺乳头状腺癌中的表达及临床意义

目的：研究Ｅ－ｃａｄｈｅｒｉｎ在甲状腺乳头状腺癌中的表达,并探讨其能否成为甲状腺乳头状腺癌独立的预后因素。方法：应用免疫组化方法,对４０例甲状腺乳头状腺癌、１０例甲状腺滤泡型腺瘤和１０例甲状腺正常组织进行了Ｅ－ｃａｄｈｅｒｉｎ表达的研究,并对可能影响甲状腺癌病人预后的有关因素进行了时序检验单因素生存分析。结果：９例（２２．５％）甲状腺乳头状腺癌Ｅ－ｃａｄｈｅｒｉｎ表达阳性,余多数呈不表达或弱阳性表     

Clinical presentations and outcomes of surgical treatment of follicular variant of the papillary thyroid carcinomas

BACKGROUND: The follicular variant of papillary thyroid carcinoma (FVPTC) presents with biological and morphological features similar to papillary thyroid carcinoma. Pre-operative diagnosis of FVPTC and its clinical course is important in identifying appropriate surgical procedures. METHODS: This study enrolled 85 patients, 68 females (mean age 41.4+/-13.7 years) and 17 males (mean age 50.1+/-12.3 years) with papillary thyroid carcinomas diagnosed as FVPTC. From the patient database at Chang Gung Medical Center (CGMC), 170 pure papillary thyroid carcinoma cases and 85 with minimally invasive follicular thyroid carcinomas of gender- and age-matched patients were randomly selected as control groups. All patients were categorized into high- and low-risk groups according to AMES criteria. RESULTS: Of the three groups, 7.1% (follicular), 11.8% (FVPTC) and 34.1% (pure papillary thyroid carcinoma) of patients presented with lymph node or soft tissue invasion (P=0.0001). Additionally, 29.4, 11.8 and 2.4% of patients with follicular carcinoma, FVPTC and pure papillary thyroid carcinoma, respectively, presented with distant metastases at the time of diagnosis. Of the 85 FVPTC cases, 75 underwent pre-operative fine needle aspiration cytology (FNAC) examination at CGMC. Only 11 cases were diagnosed pre-operatively with papillary thyroid carcinomas. Kaplan-Meier survival curves for these three groups demonstrated that follicular thyroid carcinoma had a prognosis worse than both papillary thyroid carcinomas. CONCLUSIONS: Most FVPTC cases were diagnosed as follicular neoplasm via pre-operative FNAC. In this study, FVPTC patients had a high ratio of distant metastases, few lymph node metastases and soft tissue invasion. Aggressive treatment was indicated for the high-risk FVPTC patients.     

青少年分化型甲状腺癌60例临床分析

目的:讨论青少年分化型甲状腺癌的临床表现、诊断、最佳治疗方法及预后。方法:回顾性分析1995-2010年间收治的20岁以下青少年分化型甲状腺癌60例,均为散发病例。结果:全组均行手术辅以内分泌治疗。60例青少年甲状腺癌中乳头状腺癌51例,滤泡状癌9例。伴颈淋巴结转移者17例,其中双侧甲状腺癌并双颈淋巴结转移2例,占3.3%。手术方式包括甲状腺患侧腺叶加峡部切除45例(其中行患侧功能性颈清扫8例);患侧腺叶加峡部切除及对侧大部切除13例(其中行单侧颈清扫5例,双侧颈清扫2例);甲状腺全切术加双侧颈清扫术2例。术后均予甲状腺素内分泌抑制治疗。随访时间2-17年,其中25例获得10年以上随访。5年及10年生存率均为100%。结论:青少年分化型甲状腺癌多为乳头状癌,预后较好,彩超为首选诊断检查,细针穿刺细胞学确诊率高,治疗关键在于首次手术方式的合理选择。     

儿童甲状腺癌66例临床分析

为了探讨儿童甲状腺癌的特点、治疗及预后,回顾分析浙江省肿瘤医院1963年1月～2003年12月儿童甲状腺癌66例患者的临床资料。乳头状癌46例,滤泡状癌14例,髓样癌4例,未分化癌1例,腺瘤癌变1例。单侧颈淋巴结清除26例,双侧颈淋巴结清除加双侧甲状腺次全切除4例,甲状腺全切除加双侧颈淋巴结清除5例,术后均予甲状腺素片口服。5、10和15年生存率分别为95.3%,92.5%和92.1%。回顾分析结果提示,儿童甲状腺癌预后较好,死亡率低,外科手术为主要治疗手段,选择合理术式和术后辅助治疗可达满意疗效。     

雌激素受体和细胞增殖周期调控蛋白D1在分化型甲状腺癌中的表达及意义

目的:探讨雌激素受体(ER)和细胞增殖周期调控蛋白(cyclinD1)在分化型甲状腺癌(DTC)中的表达及意义。方法:用免疫组织化学SP法研究不同甲状腺组织中ER和cyclinD1的表达。DTC43例(乳头状癌39例,滤泡状癌4例),甲状腺良性腺瘤30例,腺瘤旁正常组织16例。结果:DTC组织中ER和cyclinD1蛋白阳性率分别为53.5%(23/43)、65.1%(28/43);甲状腺良性瘤中ER和cyclinD1蛋白阳性率分别为26.7%(8/30)、36.7%(11/30);正常甲状腺组织中ER阳性率为12.5%(2/16),而cyclinD1则不表达。DTC中ER的表达明显高于甲状腺良性腺瘤和正常甲状腺组织(P<0.05);DTC中cyclinD1的表达明显高于甲状腺良性腺瘤(P<0.05);且DTC中cyclinD1和ER表达存在正相关关系(P<0.05)。结论:雌激素在DTC的发生、发展中有促进细胞增殖的作用;DTC可能为雌激素依赖性肿瘤。     

RET、HBME-1和Ki67在甲状腺良、恶性肿瘤中的表达

目的 探讨甲状腺良、恶性肿瘤中RET、HBME-1和Ki67基因蛋白的表达.方法 利用组织芯片技术采用二步法(PV-9000)进行免疫组化染色,检测22例结节性甲状腺肿、7例甲状腺滤泡性腺瘤,47例甲状腺乳头状癌、7例未分化癌、5例髓样癌、4例滤泡性癌、1例低分化岛状癌及1例鳞状细胞癌中上述3种蛋白的表达情况.结果 良性病变与恶性病变中3种蛋白的表达差异均有显著意义(P＜0.01),而良性病变中的不同类型间的差异无显著性(P＞0.05).HBME-1在甲状腺乳头状癌的阳性率高于滤泡性癌、髓样癌及未分化癌的表达,之间均有显著性差异(P＜0.01).Ki67在未分化癌阳性率高于乳头状癌的表达,二者比较差异显著(P＜0.05).结论 RET、HBME-1和Ki67的同时检测可作为良恶性甲状腺肿瘤鉴别诊断的指标,其中以HBME-1的敏感性最佳,RET次之,Ki67高表达可能是去分化、浸润和转移的标志.在甲状腺良性肿瘤中RET、HBME-1和Ki67同时阳性应视为恶变的高危状态.     

CK19、Galectin-3、HBME-1、p27及CyclinD1在甲状腺乳头状癌中的表达及意义

背景与目的:甲状腺乳头状癌的诊断有时会很困难,而淋巴结转移是甲状腺乳头状癌局部复发的主要原因并影响预后.本研究探讨CK19、Galectin-3、HBME-1、p27及CyclinD1在甲状腺乳头状癌中的表达特点和诊断价值以及p27、CyclinD1与乳头状癌淋巴结转移间的关系.方法:收集2005年1月至2008年12月间在我院手术的50例甲状腺良性病变患者 (结节性甲状腺肿40例,甲状腺腺瘤10例)及50例甲状腺乳头状癌(经典型40例,滤泡型10例) 患者的手术标本,用免疫组化EnViSion法检测CK19、HBME-1、Galectin-3、p27及CyclinD1的表达.结果:细胞质或细胞膜均有CK19、Galectin-3和HBME-1三种标志物表达,但p27和CyclinD1则在细胞核表达.CK19、HBME-1、Galectin-3在甲状腺乳头状癌中的表达阳性率分别为100%、96%和100%,而在良性病变中则为10%、10%和6%,两者比较差异有显著性(P<0.01).p27在甲状腺乳头状癌的表达阳性率为14%,而在良性病变中则为84%,两者比较差异有显著性(P<0.01).CyclinD1在甲状腺良、恶性病变中的表达阳性率分别为68%和78%,两者间差异无显著性(P>0.05).在甲状腺乳头状癌患者中,CK19、Galectin-3和HBME-1共同表达者占98%(49/50),其中伴p27低表达者占90%(45/50),而在良性病变者中则分别为2%(1/50)和0%(0/50),前两者与后者之间相比,差异有显著性(P<0.01).p27低表达与CyclinD1表达(转移组阳性率72.7%,未转移组71.4%)与甲状腺乳头状癌淋巴结转移间无显著相关性(P>0.05).结论:联合检测CK19、Galectin-3和HBME-1对甲状腺乳头状癌的诊断与鉴别诊断具有重要价值,而p27的低表达与CyclinD1表达对甲状腺乳头状癌的淋巴结转移无提示作用.